扩大经蝶窦入路颅底重建失败原因分析

摘要

Objective To analysis reason of failure of extended trans-sphenoidal approach for skull base reconstruction and subsequent postoperative CSF leakage,and to summarize the improved methods of skull base reconstruction.Methods A retrospective study of all patients who underwent extended trans-sphenoidal surgery at Peking Union Medical College Hospital from June,2009 to December,2012 identified 3 patients who experienced symptoms of CSF leakage between 7-14 days after first surgery and was requiring reoperation.All 3 patients had substantial intraoperative CSF leakage as a result of the bony and dural defects in skull base,which was repaired by the multilayer skull base reconstruction method.Cause of the failure in reconstruction was revealed in the second operation.Results Two patients had successful repair and recovery after the second operation,following up in the later 6 months to 2 years did not reveal CSF leakage any more.The other patient continued to have CSF leakage after being reoperated.He developed intracranial infection,hemorrhage,and later resulted in death of the patient.Conclusion The method of multilayer skull base reconstruction with autografted fascia lata could effectively reconstruct the skull base during extended trans-sphenoidal surgery for supraseller lesion.Special attention should be paid to make the autografted fascia and iodoform gauze large enough and compress the defect securely.%目的 分析扩大经蝶窦入路颅底重建失败的原因,总结颅底重建技术的改进方法. 方法 回顾性分析自2009年6月至2012年12月在我院19例接受扩大经蝶窦入路的病例,用自体筋膜多层颅底重建技术进行修补,其中3例术后发生脑脊液漏,探讨修补失败再手术并分析其原因. 结果 2例患者再次行颅底重建术,术后未再发生脑脊液漏.1例患者再次手术后出现颅内感染、出血、死亡. 结论 采用自体筋膜多层颅底重建技术可在扩大经蝶窦入路处理鞍上区病变时有效的重建颅底,但需要注意选择足够大小的自体筋膜、碘纺纱条压迫紧密可靠、尽量避免颅高压等因素.